Want To Have Sex With Someone Who Is HIV Positive Without Being Infected? Here Are Your Options | Sexual Health articles | Family Health center

Almost everyone has heard of HIV — the human immunodeficiency virus. Not everyone whose life hasn't been touched by it in some way knows very much about it, though, and many people will see HIV, in very abstract terms, as a scary and potentially-deadly disease that can be caught through having sex.

So if someone you're dating is HIV-positive, that can be a bit frightening. Thankfully, you have many options to reduce your risk of HIV without ditching your desire for a full and healthy sex life. What do you need to know?

First, back to basics: What's HIV?

We'll keep it very simple — and if you're already well versed in the basics, you can skip this section.

HIV is a virus that attacks the CD4 cells that play an important part in the immune system. If left untreated, this will gradually render a victim unable to fight off opportunistic infections, as they develop the final stage of HIV, acquired immunodeficiency syndrome (AIDS). Once someone develops AIDS, they will live an average of three years without treatment.

When HIV first emerged, there was no treatment. Now, if a person begins receiving antiretroviral therapy in a timely manner and keeps taking it, they can live long and otherwise healthy lives — although access to this life-saving and quality-of-life-saving treatment greatly varies, on a global level. Taking ART also means the viral load of a person with HIV can be brought down to undetectable levels.

HIV has three distinct stages; the acute infection that may cause flu-like symptoms weeks after exposure, clinical latency or dormancy, and AIDS. The more untreated HIV destroys someone's immune system, the more likely it is they will start noticing symptoms, and it is quite possible not to have noticeable symptoms beyond the general malaise that occurs during acute infection for years.

Someone can be HIV-positive without realizing it, then, and still transmit it to others. The bodily fluids that can transmit HIV are blood, semen and pre-ejaculate fluid, rectal fluids, vaginal fluids, and breast milk. For transmission to occur, these bodily fluids need to be in direct contact with yours — through contact with a mucus membrane, injured tissue, or with your blood directly. That means all sorts of activities, from untested blood transfusions to unsanitary tattooing and from sex to even intimate kissing (with tongues) can transmit HIV. In the latter case, that is because microinjuries can be present in both partners' mouths. Not all activities carry the same risk, however.

So, let's take a look at all the things you can do to prevent getting HIV if your partner is positive.

1. Use condoms. Every time.

Yes, it's true — abstinence and masturbation are the absolute safest settings when it comes to sex. Most people aren't going to be satisfied with those. Condoms aren't magic, but they do offer a protective rate of 80 percent or more, both against HIV and other sexually-transmitted diseases, as shown by a whole body of scientific evidence.

Because some people aren't going to share their status or don't know it, you won't always know whether a potential or actual sex partner has HIV or other diseases that can be spread much more easily without a condom. Knowing that your partner is HIV-positive certainly doesn't change this. Using condoms every time you have sex is one of the best things you can do for your health.

Condoms are one of the most certain ways to keep you safe, whether you know your partner has an STD or more, or you have no idea about their status — and whether you are going for anal or vaginal sex, though receptive anal sex increases your risk of contracting HIV.

Condoms also play a key role in protecting HIV-positive people from further infections that their bodies will struggle with even harder than they would if they didn't have HIV — so anyone who is HIV-positive should definitely ensure that they use condoms every time for their own protection, too.

2. Your partner uses antiretroviral therapy.

Using antiretroviral therapy consistently as instructed reduces, large international research has shown, the risk of infecting a HIV-negative partner by a whopping 93 percent. If a HIV-positive person has an undetectable viral load thanks to ART, meanwhile, the risk of transmission effectively reduces to zero. You may come across the phrase U=U, and that means undetectable equals untransmittable.

That's good news, but to keep it that way, your partner needs to take their medications as instructed every day, without any kind of pause. Even if these conditions are met, using condoms is still often encouraged for the safety of both partners. Ask your doctor if you are in a monogamous relationship and are considering ditching the condoms.

3. Consider PrEP.

PrEP, pre-exposure prophylaxis, is a combination of two medications (tenofovir and emtricitabine) that greatly reduces your risk of becoming infected with HIV, even if you are exposed to it. Typically available only to people who have a high risk of contracting HIV, including those whose partners are positive, consistently used PrEP appears to be incredibly effective while taking it occasionally doesn't help much. Ask your doctor about PrEP to add another line of defense.

4. What about oral sex?

Oral sex carries a much lower risk of transmitting HIV than vaginal or anal sex, but the risk isn't zero. Again, to add another line of defense, consider barriers or dental dams.

5. Can mixed-status heterosexual partners safely conceive?

Many people want children, and that includes cisgender heterosexual couples in which one partner is HIV-positive while the other is negative. Even if you are only just starting to date someone with HIV, the thought may be on your mind — you two could have biological children naturally, but is that possible without transmitting HIV to the potential baby or the other partner? The answer is often "yes".

HIV-positive women with undetectable viral loads and their HIV-negative partners taking PrEP may decide to try to conceive naturally, limiting unprotected intercourse to the time of ovulation. A turkey-baster style home-insemination method also works very well in this case.

Meet with your doctor before proceeding, because though ART taken consistently during pregnancy greatly reduces the risk of passing HIV onto a baby, not all medications are suitable during pregnancy.

HIV-positive men and their HIV-negative partners taking PrEP can take the same approach of having sex without a condom only during the time of ovulation, or they may opt for intrauterine insemination combined with sperm washing, a procedure that removes HIV from the semen and allows for HIV-free insemination.

A final word

We hope that this quick overview of ways to have safer sex with a HIV-positive partner conveys the idea that HIV, when treated properly, is no longer a death sentence — and that you can enjoy a full intimate relationship with a HIV-positive partner without becoming infected yourself. Under the right set of circumstances, it is even possible for cisgender, heterosexual, mixed-status couples to have biological children without any additional person getting HIV.

Continue to inform yourself, however, and primarily rely on your doctor for further advice on how to maximize both your safety and the emotional health of your relationship.